OP0213-HPR RECOMMENDATIONS FOR NURSES IN THE MANAGEMENT OF RA PATIENTS ON TREATMENT WITH JAKINIBS
Authors: J. M. Martín Martín, S. García-Díaz, A. Molina, C. Dominguez, L. Carmona, L. Cano Garcia
Journal: Annals of the Rheumatic Diseases (2022)

Background The number of new treatments available in rheumatology continues to increase. Kinase inhibitors, or jakinibs, pose an added challenge due to their variety and because they are oral. The most important role of the rheumatology nurse is patient education, especially on how to take the medication. The better the nurse understands the drugs, the better their practical recommendations and decisions will be and the better they will be able to respond to the patient. Guidelines or recommendations for inflammatory diseases do not usually include key practical details for nurses. It is our understanding that these points that will subsequently determine adherence and safety should be specially addressed in a specific document for nurses. Objectives To establish practical, evidence-based nursing recommendations for the management of people with RA undergoing treatment with jakinibs. Methods To reach an evidence-based consensus we used systematic review and Delphi survey. A multidisciplinary panel of experts was formed with 6 rheumatology nurses, 2 rheumatologists, 1 psychologist, 1 dietician-nutritionist and 1 patient on treatment with jakinibs. This panel met on 2 occasions and was kept informed at all times of the progress of the project through the Miro platform. At the preparatory meeting the scope and users, structure and PICOt questions were established (these included efficacy and adverse effects, infections, cardiovascular risk, surgery, vaccination, pregnancy and breastfeeding, interactions and switches between jakinibs). The steering group made recommendations based on the issues raised at the first meeting. Only those that achieved 65% in favour were included as items in a Delphi survey. The Delphi survey was sent to all members of the society nurses and rheumatologists (n=60). Voting ranged from 0 to 10 (strongly disagree to strongly agree). Items with more than 75% agreement in the first round did not proceed to a second round. Results The Table 1 shows the recommendations with their level of evidence and level of agreement after the Delphi (n=40; 67%). One item with only 50% agreement was rejected and did not proceed to a second round. Table 1. Recommendation Level of evidence Degree of agreement Before starting treatment with a jakinib, it should be confirmed that the patient has no contraindications. 5 100% The patient’s efficacy and outcome expectations for the drug should be explored and those that need to be adjusted. 5 85% It should be indicated that a double dose should not be taken if one is missed. 4 100% As with other DMARDs, the patient should be instructed that close management will follow. 5 99% The use of contraception and discontinuation of the drug is recommended in case of gestational desire or unplanned pregnancy. 3 96% It is recommended to explain the warning signs of infection: fever, blisters, burning pain in the ribs, itching when urinating, productive cough, diarrhoea, pus-filled wounds, phlegmon. 1a 100% It is recommended to instruct the patient on preventive measures for infectious diseases (dental and hand hygiene, HPV, social distance, etc.). 1a 89% Vaccination against common germs in immunocompromised persons and shingles with the current vaccine is recommended. 1a 93% CV risk factors should be monitored, and the patient trained for signs of thrombosis, HF or ischaemic heart disease. 1a 89% Close monitoring of elderly patients (CV risk, infections) is recommended. 2 100% Emphasis on adherence is recommended for jakinibs to be effective. 3 100% Before surgery, discontinuation of jakinib should be scheduled depending on the type of surgery and comorbidities. 3 89% Conclusion These recommendations will allow a practical approach to the management of jakinibs by nurses and enjoy an adequate consensus among potential users. Disclosure of Interests José Maria Martín Martín Speakers bureau: Lilly, Consultant of: Lilly, Grant/research support from: Galapagos, Silvia García-Díaz Grant/research support from: Galapagos, Amparo Molina Grant/research support from: Galapagos, Carmen Dominguez Grant/research support from: Galapagos, Loreto Carmona: None declared, Laura Cano Garcia Grant/research support from: Galapagos